Provider Demographics
NPI:1336476209
Name:KASTEN, JAMIE LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:KASTEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-3648
Mailing Address - Country:US
Mailing Address - Phone:361-232-0946
Mailing Address - Fax:
Practice Address - Street 1:505 POPE AVE
Practice Address - Street 2:MUNSON ARMY HEALTH CENTER (ATTN: MCXN-COD, MR. KENNEDY
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2332
Practice Address - Country:US
Practice Address - Phone:913-684-6143
Practice Address - Fax:913-684-6208
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23-37909-71164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse